| ACNE VULGARIS
(PIMPLES) |
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 WHAT IS ACNE VULGARIS?
Acne vulgaris, or acne for short, is the medical term for teenage spots (pimples). Almost everyone gets acne during puberty. For some people, it is just a few spots, while for others it is an extensive skin condition that can cause many psychological problems and spoil their enjoyment of everyday life.
Acne can sometimes persist after puberty, or start in adulthood.
HOW DOES ACNE VULGARIS DEVELOP?
Acne is caused by inflammation of the skin around the sebaceous glands (sebaceous follicles). Various
factors play a role in the development of acne. In most cases, acne starts during puberty, when the
skin undergoes all kinds of changes under the influence of hormones.
The sebaceous glands in the face, back, and chest become larger and produce more skin oil or sebum.
If too much sebum is secreted, it can accumulate and block the sebaceous gland's duct. These
accumulations of sebum are called blackheads or comedones. There are superficial, open blackheads
(black comedones) and more subcutaneous, closed blackheads (white comedones). The
accumulation of sebum is exacerbated by increased keratinization of the sebaceous gland duct, which
causes it to narrow. The sebaceous glands contain bacteria that convert sebum into fatty acids. The
accumulated sebum and irritating free fatty acids cause the blocked follicle to expand further and
eventually rupture. The irritants enter the adjacent skin and cause inflammation. This results in
pimples and spots.
Some forms of acne are caused by external factors. This usually involves contact with substances that
cause blockage of the sebaceous gland, such as certain cosmetics. Other examples include oil-based
or chemical products used in certain professions and industries. Mechanical factors (pressure and
rubbing) can also aggravate existing acne. Examples include acne under the chin strap of a helmet
and on the forehead under a headband.
Finally, there are various medications that can cause acne to develop or worsen, such as prednisone
and drugs used to treat tuberculosis and epilepsy.
ACNE HAS NOTHING TO DO WITH:
Eating the wrong foods
Because acne is often associated with oily skin, it is often thought that fatty foods promote the
development of acne. Pork, chocolate, and French fries are particularly considered to be the culprits.
Scientific research has never been able to prove this connection. Food allergies also play no role in
acne.
Vitamin deficiency
It therefore makes no sense to take vitamin supplements to combat acne.
Poor hygiene
This is also a myth. Hygiene is not related to acne. Excessive washing with soap and water is pointless
and can even be harmful to the skin.
Infections
Acne is not an infectious disease and is therefore never transmitted from one person to another.
Perspiration
Sebum production and perspiration are not related. Heavy perspiration does not affect the severity of
acne.
Tension or stress
In fact, the opposite is true: severe acne can cause considerable psychological stress (feelings of
inferiority).
WHAT ARE THE SYMPTOMS?
Acne vulgaris is characterized by the presence of blackheads (comedones), red pimples (papules), and
pustules. Severe inflammation can cause subcutaneous inflammation, which can leave unsightly scars
after healing. Squeezing pimples or scratching promotes inflammation.
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acne vulgaris |
acne vulgaris |
acne conglobata |
SPECIAL FORMS OF ACNE
In addition to acne vulgaris, which means "common" (most common form of acne), there are several
other forms of acne with a different appearance or course.
Acne conglobata
Acne conglobata is a severe form that mainly affects men and often persists long after the age of 20.
The inflammation is much more severe than with common acne (acne vulgaris). The shoulders, back,
and chest are generally more severely affected than the face. Characteristic features are double
comedones, large subcutaneous nodules, and abscesses (pus-filled cavities), which eventually heal,
leaving unsightly scars.
Acne ectopica (hidradenitis suppurativa)
This is a variant of acne that occurs in unusual places, such
as the armpits, groin, and buttocks. It can be very severe. The recurring inflammation and abscesses
can cause the patient a great deal of discomfort. This form of acne usually occurs after the age of 20,
particularly in smokers. See also hidradenitis suppurativa.
Acne excoriée (excoriated acne)
Some people with acne, often young women with mild acne, can become so obsessed with their skin
condition that they scratch or squeeze every pimple. This only makes the inflammation worse and
causes scarring.
HOW IS THE DIAGNOSIS MADE?
Acne is generally easy to recognize, so the diagnosis can usually be made on the basis of the visible
abnormalities. Additional testing is almost never necessary.
Acne is often classified as mild, moderate, or severe based on the number of pimples and spots and
their extent. The presence of scars also plays a role in assessing the severity of acne.
WHAT IS THE BEST TREATMENT?
Although the treatment options for acne have increased enormously in recent years, acne remains a
chronic condition. Acne does not disappear overnight.
Even milder forms of acne often require long-term attention. Acne cannot always be cured. However,
it is usually possible to ensure that the acne becomes "quiet" and remains so until it eventually clears
up on its own.
There is no standard treatment for acne. When the inflammatory symptoms are prominent, the
treatment is different than when there are mainly blackheads.
The severity of the condition, the symptoms, the occurrence of scarring, but also age and gender
determine which anti-acne medication will be used.
There are various treatments available that work in different ways:
Medications that counteract the increased keratinization of the duct
These include benzoyl peroxide, tretinoin, and adapalene. They are applied in a cream, gel, or lotion.
These agents cause the skin to peel, allowing sebum to escape easily. This prevents the formation of
blackheads. Benzoyl peroxide also inhibits bacterial growth to a small extent. For mild forms of acne,
benzoyl peroxide, tretinoin, or adapalene can be applied once a day.
One drawback of benzoyl peroxide, tretinoin, and adapalene is that these substances often irritate
the skin at the start of treatment. If necessary, the strength can be reduced or the product can be
applied every other day.
Medications that inhibit bacterial growth
In addition to the aforementioned benzoyl peroxide, and antibiotics are the main agents that inhibit
bacterial growth. They can be applied both externally and internally, often in combination with
tretinoin, adapalene, or benzoyl peroxide. Antibiotics are usually used for moderate to severe acne.
The antibiotics most commonly used internally are doxycycline and minocycline. If this type of
treatment is chosen, the antibiotic must be administered for a longer period of time (3 to a maximum
of 6 months). Antibiotics that are applied externally in a gel or lotion are erythromycin and
clindamycin.
Anti-inflammatory agents
Some antibiotics, including the aforementioned doxycycline and minocycline, also have an anti-
inflammatory effect.
Agents that reduce sebum production
It has long been known that contraceptive pills can influence sebum production. There are contraceptive pills on the market that have a beneficial effect on acne. This is recommended for women who want to use a contraceptive pill in addition to acne treatment.
Another drug that suppresses sebum production is isotretinoin. This drug contains a substance
related to vitamin A. It is a very effective drug for internal use. In addition to suppressing sebum
production, isotretinoin has an inhibitory effect on abnormal keratinization in the sebaceous gland
duct and suppresses the inflammatory response. It is only prescribed for severe forms of acne that do
not respond adequately to other medications.
The most common side effect is dryness of the lips, nasal mucosa, eyes, and skin. Sometimes liver
enzymes and fats in the blood may increase during treatment. Therefore, blood tests are necessary.
Isotretinoin carries serious risks when used during pregnancy. It can cause severe congenital
abnormalities. For this reason, pregnancy must be ruled out before treatment can begin. Women of
childbearing age must also take extra measures to prevent pregnancy during treatment and for up to
one month after stopping treatment.
The advantages and disadvantages of this treatment must be carefully weighed against each other.
Psychotherapy
If the pimples spoil your daily life to such an extent that you can think of nothing else and feel
depressed, psychotherapy can be a useful addition to your treatment. Behavioral therapy can help
you overcome the urge to constantly pick at every pimple, which only makes the acne worse or keeps
it going.
WHAT ELSE CAN YOU DO YOURSELF?
The ultraviolet rays in sunlight can have a temporary beneficial effect on acne. However, excessive
exposure to sunlight or artificial UV sources is not recommended due to the risk of skin cancer. It is important to realize that some treatments prescribed by doctors for acne (such as isotretinoin and certain antibiotics) make the skin extra sensitive to sunlight.
Acne treatment always takes time to be effective. It usually takes at least 1 to 3 months before
satisfactory results are achieved.
Most patients with acne suffer from increased sebum production. This can manifest itself in an oily,
shiny face. By cleansing the skin beforehand, you can remove the excess sebum. Excessive washing
with soap and water is pointless and can even be harmful to the skin. It is recommended to wash the
skin daily with lukewarm water, without rubbing or scrubbing.
Squeezing or scrubbing blackheads,
pimples, and spots yourself can lead to scarring and worsening of the pimples and is therefore not
recommended.
Dry skin may occur during treatment. A moisturizing cream can sometimes help, but be careful that
the cream is not too oily, as this can cause pimples.
The ultraviolet rays in sunlight can have a temporary beneficial effect on acne. However, excessive
exposure to sunlight or artificial UV sources is not recommended due to the risk of skin cancer. It is important to realize that some treatments prescribed by
doctors for acne (such as isotretinoin and certain antibiotics) can make the skin more sensitive to
sunlight.
Finally, it is wise not to switch from one medication to another. If a particular medication is not
sufficiently effective, it is often better to add another medication to the treatment. Because several
factors play a role in the development of acne, a combination treatment will usually be necessary to
combat the condition on several fronts at once.
WHAT ARE THE EXPECTATIONS, WHAT IS THE PROGNOSIS?
Acne is a harmless condition that usually disappears on its own after a few years. The treatments
mentioned above can largely prevent lifelong scarring. Acne usually disappears before the age of 25,
but sometimes the condition persists into older age.
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